Definitions

fullterm

Stillbirth

[stil-burth]

A stillbirth occurs when a fetus which has died in the uterus or during labor or delivery exits a woman's body. The term is often used in distinction to live birth or miscarriage. Most stillbirths occur in full term pregnancies.

Some sources reserve the term "stillbirth" for a fetus which has died after reaching mid-second trimester to full term gestational age. For example, in the United Kingdom, "stillbirth" is used to describe an infant delivered without life after 24 weeks gestation. The sources that use this definition tend to use the term "miscarriage" if the death occurs earlier in development. In contrast, other sources use the term "stillbirth" regardless of the stage of fetal development.

Human stillbirth

Causes

The causes of a large percentage of human stillbirths remain unknown, even in cases where extensive testing and autopsy have been performed. The term used to describe these is sudden antenatal death syndrome or SADS. In cases where the cause is known, some possibilities of the cause of death are:

Prenatal diagnosis

A decrease or cessation of fetal activity may be an indication of fetal distress or death, though it is not entirely uncommon for a healthy fetus to exhibit such changes, particularly near the end of a pregnancy when there is considerably little space in the uterus for the fetus to move about. Still, medical examination, including a nonstress test, is recommended in the event of any change in the strength or frequency of fetal movement, especially a complete cease; most midwives and obstetricians recommend the use of a kick chart to assist in detecting any changes. Fetal distress or death can be confirmed or ruled out via fetoscopy/doptone, ultrasound, and/or electronic fetal monitoring. If the fetus is alive but inactive, extra attention will be given to the placenta and umbilical cord during ultrasound examination to ensure that there is no compromise of oxygen and nutrient delivery.

Prenatal maternal treatment

An in utero stillbirth does not usually present an immediate health risk to the woman and labour will usually begin spontaneously after two weeks, so the woman may choose to wait and deliver vaginally. After two weeks, the woman is at risk of developing blood clotting problems, and induction is recommended at this point. In many cases, the woman will find the idea of carrying the dead baby emotionally traumatizing and will elect to be induced. Cesarean birth is not recommended unless complications develop during vaginal birth.

Prevalence

Stillbirth is a relatively common, but often random, occurrence. The mean stillbirth rate in the United States is approximately 1 in 115 births, which is roughly 26,000 stillbirths each year, or on an average one every 20 minutes. In Australia, England, Wales, and Northern Ireland, the rate is approximately 1 in every 200 births, in Scotland 1 in 167. (From The National Statistical Office and other sources.) Many stillbirths occur at fullterm to apparently healthy mothers, and a postmortem evaluation reveals a cause of death in only about 40% of autopsied cases.

In developing countries, where medical care can be of low quality or unavailable, the stillbirth rate is much higher.

Legal definitions of stillbirth

Australia

In Australia any stillborn baby weighing more than 400 grams, or more than 20 weeks in gestation, must have its birth registered.

Canada

Beginning in 1959, "the definition of a stillbirth was revised to conform, in substance, to the definition of fetal death recommended by the World Health Organization." The definition of "fetal death" promulgated by the World Health Organization in 1950 is as follows:
"Fetal death" means death prior to the complete expulsion or extraction from its mother of a product of human conception, irrespective of the duration of pregnancy and which is not an induced termination of pregnancy. The death is indicated by the fact that after such expulsion or extraction, the fetus does not breathe or show any other evidence of life, such as beating of the heart, pulsation of the umbilical cord, or definite movement of voluntary muscles. Heartbeats are to be distinguished from transient cardiac contractions; respirations are to be distinguished from fleeting respiratory efforts or gasps.

United Kingdom

Throughout the United Kingdom, stillbirths must be registered by law. The Stillbirth Definition Act (1992) states: "any ‘child’ expelled or issued forth from its mother after the 24th week of pregnancy that did not breathe or show any other signs of life should be registered as a stillbirth." In England and Wales, this must be done within 42 days and a Stillbirth Certificate is issued to the parent(s). In Scotland, this must be done within 21 days.

United States

In the United States, there is no standard definition of the term 'stillbirth'. The Centers for Disease Control and Prevention collects statistical information on "live births, fetal deaths, and induced termination of pregnancy" from 57 reporting areas in the United States. Each reporting area has different guidelines and definitions for what is being reported; many do not use the term "stillbirth" at all. The federal guidelines suggests (at page 1) that fetal death and stillbirth can be interchangeable terms. The CDC definition of "fetal death" is based on the definition promulgated by the World Health Organization in 1950 (see section above on Canada). The federal guidelines recommend reporting those fetal deaths whose birth weight is over 350g, or those more than 20 weeks gestation. Forty-one areas use a definition very similar to the federal definition, thirteen areas use a shortened definition of fetal death, and three areas have no formal definition of fetal death. Only 11 areas specifically use the term 'stillbirth' , often synonymously with late fetal death, however they are split between whether stillbirths are "irrespective of the duration of pregnancy", or whether some age or weight constraint is applied.

See also

Childbirth

References

External links

Grieving resources

  • MISSing Angels Bill Legislation for Stillbirth Grassroots movement of bereaved stillbirth families, a program of the MISS Foundation
  • The Forgotten Grief: Miscarriage, Stillbirth and Neo-natal Death
  • MISS Foundation support site for those bereaved of a child and advice for professionals on their support.
  • SANDS AUSTRALIA providing support, information & counselling for bereaved parents & families
  • First Candle First Candle promotes safe pregnancies and the survival of babies through the first years of life. With programs of research, education and advocacy, they are working toward a future where all babies are provided the best possible chance to reach not only their first birthday, but many happy birthdays beyond. Until this goal is reached, they remain committed to providing compassionate grief support to all those affected by the death of a baby.

Activism/Prevention

  • MISS Foundation an activist site of the MISS Foundation for parents of stillborn infants.
  • National Stillbirth Society an activist group of parents for stillbirth education.
  • Preferred Pregnancy Protocol for minimizing the risk of stillbirth due to cord accidents.
  • Dr. Joanne Cacciatore Arizona State University researcher who specializes in stillbirth and traumatic loss.
  • International Stillbirth Alliance is a non-profit coalition of organizations dedicated to understanding the causes and prevention of stillbirth.
  • First Candle First Candle promotes safe pregnancies and the survival of babies through the first years of life. With programs of research, education and advocacy, they are working toward a future where all babies are provided the best possible chance to reach not only their first birthday, but many happy birthdays beyond. Until this goal is reached, they remain committed to providing compassionate grief support to all those affected by the death of a baby.

Factual/Reference

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